Don Finley: Donuts and diabetes

SAN FRANCISCO &#151 While the Medicare Part D drug benefit has been a boon to many, a looming concern has been the infamous “donut hole” &#151 the gap in coverage after about $2,000 in benefits are paid. Do patients drop their medications until the benefits resume?

The answer: Not that many &#151 at least according to a new study that examined pharmacy claims information for more than 324,000 elderly diabetics on insulin therapy covered by the Part D benefit.

That study found that because of additional government subsidies for many low-income patients, only 12 percent actually saw a gap in coverage. Among those, about 40 percent dropped some or all of their medicines after reaching the donut hole.

“Almost half of them continued on all of their products when they entered the coverage gap,” said Christopher Conner, a health policy analyst for the pharmaceutical company Novo Nordisk Inc., and one of the co-authors. “We did see that for some of those patients, there was some change made to their therapy.”

The study, led by researchers at the University Of Arizona College Of Pharmacy, was presented Saturday at the American Diabetes Association’s 68th annual scientific sessions.

The study found that 24 percent of those who experienced a coverage gap dropped at least some of their medicines, and 16 percent dropped all of them. What the data couldn’t show is whether some of those who dropped medicines started on different ones.

But Rosette Davila, vice president of the family-owned Davila Pharmacy on San Antonio’s West Side, said she often sees patients quitting their medications after reaching the donut hole.

“The bad part, too is, if they’re not buying their meds they’re not going to purchase their way through the donut hole,” said Davila, referring for the amount patients have to spend out-of-pocket before coverage resumes.

“Some of the insulins are really expensive, particularly at the high doses we’re seeing. So the patient’s faced with potentially paying $300 for their insulin for the month. For those people who don’t qualify for the extra help, they’re in a real bind.”

The study covered 2006, the first year of the Part D program. That year, the donut hole began after $2,250 in drug costs &#151 a figure than has risen a bit in 2007 and 2008 &#151 and resumed after $5,100 in spending.

However, 40.6 percent of those insulin-dependent diabetics were covered both by Medicare and Medicaid and so were exempted from the donut hole under the rules. Another 32.4 percent were eligible for extra coverage because of their low family incomes.